Effectiveness of a school-based physical activity intervention on obesity in school children: a nonrandomized controlled trial

Xiao-Hui Li, Shenting Lin, Hongxia Guo, Yanli Huang, Lijing Wu, Zilong Zhang, Jun Ma, Hai-Jun Wang, Xiao-Hui Li, Shenting Lin, Hongxia Guo, Yanli Huang, Lijing Wu, Zilong Zhang, Jun Ma, Hai-Jun Wang

Abstract

Background: Childhood obesity has been a serious public health problem. An effective school-based physical activity (PA) intervention is still lacking in China. This study aimed to assess the effectiveness of a school-based physical activity intervention during 12 weeks on obesity and related health outcomes in school children.

Methods: It was a non-randomized controlled trial. Altogether 921 children aged 7 to 15 years were recruited at baseline survey. Children in the intervention group (n = 388) participated in a multi-component physical activity intervention during 12 weeks that included improvement of physical education, extracurricular physical activities for overweight/obese students, physical activities at home, and health education lectures for students and parents. Children (n = 533) in the control group participated in usual practice.

Results: Participants had mean age of 10.4 years, mean body mass index (BMI) of 19.59 kg/m2, and 36.8 % of them were overweight or obese at baseline survey. The change in BMI in intervention group (-0.02 ± 0.06 kg/m2) was significantly different from that in control group (0.41 ± 0.08 kg/m2). The adjusted mean difference was -0.43 kg/m2 (95% CI: -0.63 to -0.23 kg/m2, P < 0.001). The effects on triceps, subscapular, abdominal skinfold thickness and fasting glucose were also significant in intervention group compared with control group (all P < 0.05). The change in duration of moderate to vigorous physical activity (MVPA) in intervention group (8.9 ± 4.3 min/day) was significantly different from that in control group (-13.8 ± 3.3 min/day). The adjusted mean difference was 22.7 min/day (95% CI: 12.2 to 33.2 min/day, P < 0.001).

Conclusions: The school-based, multi-component physical activity intervention was effective to decreasing levels of BMI, skinfold thickness, fasting glucose and increasing duration of MVPA. These findings provided evidence for the development of effective and feasible school-based obesity interventions.

Trial registration: Clinicaltrials.gov Identifier: NCT02074332 (2014-02-26).

Figures

Figure 1
Figure 1
Flow diagram of the study.
Figure 2
Figure 2
Changes in proportion of subjects’ nutritional status from baseline to follow-up survey in intervention and control group.

References

    1. Misra A, Bhardwaj S. Obesity and the metabolic syndrome in developing countries: focus on South Asians. Nestle Nutr Inst work Ser. 2014;78:133–140. doi: 10.1159/000354952.
    1. Gupta N, Shah P, Nayyar S, Misra A. Childhood obesity and the metabolic syndrome in developing countries. Indian J Pediatr. 2013;80(Suppl 1):S28–S37. doi: 10.1007/s12098-012-0923-5.
    1. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NM, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–781. doi: 10.1016/S0140-6736(14)60460-8.
    1. Wang Y, Beydoun MA. The obesity epidemic in the United States–gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev. 2007;29:6–28. doi: 10.1093/epirev/mxm007.
    1. Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes. 2006;1(1):11–25. doi: 10.1080/17477160600586747.
    1. Wang Y, Lim H. The global childhood obesity epidemic and the association between socio-economic status and childhood obesity. Int Rev Psychiatr. 2012;24(3):176–188. doi: 10.3109/09540261.2012.688195.
    1. Ma J, Cai CH, Wang HJ, Dong B, Song Y, Hu PJ, Zhang B. The trend analysis of overweight and obesity in Chinese students during 1985–2010. Chin J Prev Med. 2012;46(9):776–780.
    1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA : J Am Med Assoc. 2006;295(13):1549–1555. doi: 10.1001/jama.295.13.1549.
    1. Cossrow N, Falkner B. Race/ethnic issues in obesity and obesity-related comorbidities. J Clin Endocrinol Metab. 2004;89(6):2590–2594. doi: 10.1210/jc.2004-0339.
    1. Chen J, Muntner P, Hamm LL, Jones DW, Batuman V, Fonseca V, Whelton PK, He J. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med. 2004;140(3):167–174. doi: 10.7326/0003-4819-140-3-200402030-00007.
    1. Davis CE, Hunsberger S, Murray DM, Fabsitz RR, Himes JH, Stephenson LK, Caballero B, Skipper B. Design and statistical analysis for the Pathways study. Am J Clin Nutr. 1999;69(4 Suppl):760S–763S.
    1. Metcalf BS, Hosking J, Jeffery AN, Voss LD, Henley W, Wilkin TJ. Fatness leads to inactivity, but inactivity does not lead to fatness: a longitudinal study in children (EarlyBird 45) Arch Dis Child. 2011;96(10):942–947. doi: 10.1136/adc.2009.175927.
    1. Ball EJ, O'Connor J, Abbott R, Steinbeck KS, Davies PS, Wishart C, Gaskin KJ, Baur LA. Total energy expenditure, body fatness, and physical activity in children aged 6–9 y. Am J Clin Nutr. 2001;74(4):524–528.
    1. Wareham N. Physical activity and obesity prevention. Obes Rev: Off J Int Assoc Study Obes. 2007;8(Suppl 1):109–114. doi: 10.1111/j.1467-789X.2007.00328.x.
    1. Eaton DK, Kann L, Kinchen S, Shanklin S, Flint KH, Hawkins J, Harris WA, Lowry R, McManus T, Chyen D, Whittle L, Lim C, Wechsler H, Centers for Disease C Prevention Youth risk behavior surveillance - United States, 2011. Morb Mortal Wkly Rep Surveill Summ. 2012;61(4):1–162.
    1. Al-Hazzaa HM, Abahussain NA, Al-Sobayel HI, Qahwaji DM, Musaiger AO. Physical activity, sedentary behaviors and dietary habits among Saudi adolescents relative to age, gender and region. Int J Behav Nutr Phys Act. 2011;8:140. doi: 10.1186/1479-5868-8-140.
    1. Mushtaq MU, Gull S, Mushtaq K, Shahid U, Shad MA, Akram J. Dietary behaviors, physical activity and sedentary lifestyle associated with overweight and obesity, and their socio-demographic correlates, among Pakistani primary school children. Int J Behav Nutr Phys Act. 2011;8:130. doi: 10.1186/1479-5868-8-130.
    1. Zhang X, Song Y, Yang TB, Zhang B, Dong B, Ma J. Analysis of current situation of physical activity and influencing factors in Chinese primary and middle school students in 2010. Chin J Prev Med. 2012;46(9):781–788.
    1. Carrel AL, Clark RR, Peterson SE, Nemeth BA, Sullivan J, Allen DB. Improvement of fitness, body composition, and insulin sensitivity in overweight children in a school-based exercise program: a randomized, controlled study. Arch Pediatr Adolesc Med. 2005;159(10):963–968. doi: 10.1001/archpedi.159.10.963.
    1. Harris KC, Kuramoto LK, Schulzer M, Retallack JE. Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ. 2009;180(7):719–726. doi: 10.1503/cmaj.080966.
    1. Dobbins M, De Corby K, Robeson P, Husson H, Tirilis D. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6–18. Cochrane Database Syst Rev. 2009;1:CD007651.
    1. Kriemler S, Zahner L, Schindler C, Meyer U, Hartmann T, Hebestreit H, Brunner-La Rocca HP, van Mechelen W, Puder JJ. Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren: cluster randomised controlled trial. BMJ. 2010;340:c785. doi: 10.1136/bmj.c785.
    1. Barbeau P, Johnson MH, Howe CA, Allison J, Davis CL, Gutin B, Lemmon CR. Ten months of exercise improves general and visceral adiposity, bone, and fitness in black girls. Obesity. 2007;15(8):2077–2085. doi: 10.1038/oby.2007.247.
    1. Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;12:CD001871.
    1. Lavelle HV, Mackay DF, Pell JP. Systematic review and meta-analysis of school-based interventions to reduce body mass index. J Pub Health. 2012;34(3):360–369. doi: 10.1093/pubmed/fdr116.
    1. Jiang J, Xia X, Greiner T, Wu G, Lian G, Rosenqvist U. The effects of a 3-year obesity intervention in schoolchildren in Beijing. Child Care Health Dev. 2007;33(5):641–646. doi: 10.1111/j.1365-2214.2007.00738.x.
    1. Li YP, Hu XQ, Schouten EG, Liu AL, Du SM, Li LZ, Cui ZH, Wang D, Kok FJ, Hu FB, Ma GS. Report on childhood obesity in China (8): effects and sustainability of physical activity intervention on body composition of Chinese youth. Biomed Environ Sci. 2010;23(3):180–187. doi: 10.1016/S0895-3988(10)60050-5.
    1. Liu AL, Hu XQ, Ma GS, Cui ZH, Pan YP, Chang SY, Zhao WH, Chen CM. Report on childhood obesity in China (6) evaluation of a classroom-based physical activity promotion program. Biomed Environ. 2007;20(1):19–23.
    1. Salmon J, Booth ML, Phongsavan P, Murphy N, Timperio A. Promoting physical activity participation among children and adolescents. Epidemiol Rev. 2007;29:144–159. doi: 10.1093/epirev/mxm010.
    1. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351–377. doi: 10.1177/109019818801500401.
    1. Booth SL, Sallis JF, Ritenbaugh C, Hill JO, Birch LL, Frank LD, Glanz K, Himmelgreen DA, Mudd M, Popkin BM, Rickard KA, St Jeor S, Hays NP. Environmental and societal factors affect food choice and physical activity: rationale, influences, and leverage points. Nutr Rev. 2001;59(3 Pt 2):S21–S39.
    1. Muller MJ, Danielzik S, Pust S. School- and family-based interventions to prevent overweight in children. Proc Nutr Soc. 2005;64(2):249–254. doi: 10.1079/PNS2005424.
    1. Thompson WR, Gordon NF, Pescatello LS, American College of Sports Medicine . ACSM's guidelines for exercise testing and prescription. 8. Philadelphia: Lippincott Williams & Wilkins; 2010.
    1. da Cunha FA, Farinatti Pde T, Midgley AW. Methodological and practical application issues in exercise prescription using the heart rate reserve and oxygen uptake reserve methods. J Sci Med Sport/Sports Med Aust. 2011;14(1):46–57. doi: 10.1016/j.jsams.2010.07.008.
    1. Ji CY, Working Group on Obesity in C Report on childhood obesity in China (1)–body mass index reference for screening overweight and obesity in Chinese school-age children. Biomed Environ Sci. 2005;18(6):390–400.
    1. Liu AL, Ma GS, Zhang Q, Ma WJ. Reliability and validity of a 7-day physical activity questionnaire for elementary students. Chin J Epidemiol. 2003;24(10):901–904.
    1. Li XH, Ma J, Wang HJ, Dong B, Fu LG, Song Y, Hu PJ, Yang YD, Wu LJ, Meng XR. Analysis of influencing factors on physical endurance of Chinese primary and middle school students aged 10 to 17. Chin J Prev Med. 2013;47(8):700–706.
    1. Timperio A, Salmon J, Ball K. Evidence-based strategies to promote physical activity among children, adolescents and young adults: review and update. J Sci Med Sport/Sports Med Aust. 2004;7(1 Suppl):20–29. doi: 10.1016/S1440-2440(04)80274-3.
    1. Centers for Disease C, Prevention Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation--United States, 2003–2005. MMWR Morb Mortal Wkly Rep. 2006;55(40):1089–1092.
    1. Gonzalez-Suarez C, Worley A, Grimmer-Somers K, Dones V. School-based interventions on childhood obesity: a meta-analysis. Am J Prev Med. 2009;37(5):418–427. doi: 10.1016/j.amepre.2009.07.012.
    1. Simon C, Schweitzer B, Oujaa M, Wagner A, Arveiler D, Triby E, Copin N, Blanc S, Platat C. Successful overweight prevention in adolescents by increasing physical activity: a 4-year randomized controlled intervention. Int J Obes. 2008;32(10):1489–1498. doi: 10.1038/ijo.2008.99.
    1. Baker JL, Olsen LW, Sorensen TI. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med. 2007;357(23):2329–2337. doi: 10.1056/NEJMoa072515.
    1. Must A, Jacques PF, Dallal GE, Bajema CJ, Dietz WH. Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl J Med. 1992;327(19):1350–1355. doi: 10.1056/NEJM199211053271904.
    1. Seipel MM, Shafer K. The effect of prenatal and postnatal care on childhood obesity. Soc Work. 2013;58(3):241–252. doi: 10.1093/sw/swt025.
    1. Haerens L, De Bourdeaudhuij I, Maes L, Cardon G, Deforche B. School-based randomized controlled trial of a physical activity intervention among adolescents. J Adolesc Health. 2007;40(3):258–265. doi: 10.1016/j.jadohealth.2006.09.028.
    1. Ardoy DN, Artero EG, Ruiz JR, Labayen I, Sjostrom M, Castillo MJ, Ortega FB. Effects on adolescents' lipid profile of a fitness-enhancing intervention in the school setting; the EDUFIT study. Nutr Hosp. 2013;28(1):119–126.
    1. Salcedo Aguilar F, Martinez-Vizcaino V, Sanchez Lopez M, Solera Martinez M, Franquelo Gutierrez R, Serrano Martinez S, Lopez-Garcia E, Rodriguez-Artalejo F. Impact of an after-school physical activity program on obesity in children. J Pediatr. 2010;157(1):36 e33–42 e33. doi: 10.1016/j.jpeds.2009.12.046.
    1. Knox GJ, Baker JS, Davies B, Rees A, Morgan K, Cooper SM, Brophy S, Thomas NE. Effects of a novel school-based cross-curricular physical activity intervention on cardiovascular disease risk factors in 11- to 14-year-olds: the activity knowledge circuit. Am J Health Promot. 2012;27(2):75–83. doi: 10.4278/ajhp.110617-QUAN-258.
    1. Eliakim A, Scheett TP, Newcomb R, Mohan S, Cooper DM. Fitness, training, and the growth hormone–>insulin-like growth factor I axis in prepubertal girls. J Clin Endocrinol Metab. 2001;86(6):2797–2802.
    1. Wang H, Zhai F. Programme and policy options for preventing obesity in China. Obes Rev. 2013;14(Suppl 2):134–140. doi: 10.1111/obr.12106.
    1. Hills AP, Dengel DR, Lubans DR. Prog Cardiovasc Dis. 2014. Supporting Public Health Priorities: Recommendations for Physical Education and Physical Activity Promotion in Schools.
    1. Ickes MJ, McMullen J, Haider T, Sharma M. Global school-based childhood obesity interventions: a review. Int J Environ Res Pub Health. 2014;11(9):8940–8961. doi: 10.3390/ijerph110908940.
    1. Morris FL, Naughton GA, Gibbs JL, Carlson JS, Wark JD. Prospective ten-month exercise intervention in premenarcheal girls: positive effects on bone and lean mass. J Bone Miner Res. 1997;12(9):1453–1462. doi: 10.1359/jbmr.1997.12.9.1453.
    1. Sharma M. School-based interventions for childhood and adolescent obesity. Obes Rev. 2006;7(3):261–269. doi: 10.1111/j.1467-789X.2006.00227.x.
Pre-publication history
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